Provider Demographics
NPI:1801907811
Name:GOLDEN, ROBERT MYLES (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MYLES
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3032
Mailing Address - Country:US
Mailing Address - Phone:781-828-2212
Mailing Address - Fax:781-828-1771
Practice Address - Street 1:612 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3032
Practice Address - Country:US
Practice Address - Phone:781-828-2212
Practice Address - Fax:781-828-1771
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2095TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0306312Medicaid
MA726747OtherTUFTS HEALTH PLAN
MAW15016OtherBCBSMA
MA0306312Medicaid
MAW15016OtherBCBSMA